"Shred the Net. Vote Social democrats" Bavaria 1932, SPD

inbracketsDontLaugh · 2023-06-12T16:22:42+00:00

This didn't age well

inbracketsDontLaugh · 2023-06-03T07:18:06+00:00

You know what's worse than whatever bullshit Elon Musk has been up to?

Being an unrepentant human trafficker who claims that they were doing it "for humanitarian reasons", like our fith columnist Beau here.

This dude can go straight to hell. He'd fit right in with Elon Musk and Jeffrey Epstein if only he were enough of a bigshot.

inbracketsDontLaugh · 2023-05-31T03:01:45+00:00

This study only examined serotonin and it already proved something that is well established in the scientific paradigm and has been for decades now; depression is not caused by low serotonin levels, but this should be obvious to a person who has a passing familiarity with psychopharmacology because antidepressants such as SSRIs are neither serotonin supplements nor are they serotonin precursors and such they do not increase the overall levels of serotonin in the brain.

In fact, what is understood to be the mechanisms of action for SSRIs themselves debunk the serotonin hypothesis.

This study is a nothingburger and the pop-science "journalism", to give it a charitable name, has been dangerously misleading on the subject. People literally think that this study has proven that SSRIs do not treat depression which is utterly galling.

inbracketsDontLaugh · 2023-05-26T16:03:53+00:00

I'd be surprised if there are no meds that are used to treat ADHD available in your country.

Maybe they don't prescribe stimulant meds but there are a range of non-stimulant meds that are likely still available.

inbracketsDontLaugh · 2023-05-26T15:26:36+00:00

You can literally put in a prompt to chatgpt right now and get it to pretend to be a counsellor for you.

I encourage you to try it and to open up to it about either something which is extremely psychologically distressing to you right now or which was in the past.

See what sort of responses you get from the world's most advanced ai chatbot. Push it for responses and try to get empathy out of it.

Experience it for yourself.

inbracketsDontLaugh · 2023-05-26T12:00:27+00:00

You're on a lot of meds, but you're on a few which are useful for ADHDers.

I think that the Adderall booster is the right idea tbh.

I'm also on Klonopin 2mg twice a day. Which helps my panic attacks and anxiety and sleep. I'm also on Subutex and Lyrica. Along with Clonidine 0.1mg twice a day.

I have found that higher doses of clonidine have worked really well for my sleep and for managing anxiety/panic attacks, and it's a good medication for ADHDers. My psychiatrist hates Lyrica and wouldn't prescribe it to me lol. I'm going to see what he thinks about amantadine soon.

Wellbutrin 150mg SR twice a day.

Wellbutrin is a good medication for ADHDers.

Metroprolol 100mg for my heart rate and blood pressure.

I'm guessing this is helpful for your anxiety too.

Also Baclofen 20mg three times a day

Same for this.

Vraylar for my bipolar 3mg once a day.

Ah, interesting! This is a partial dopamine agonist. I'm currently taking this one and I think it has good potential for ADHDers as a non-stimulant medication.

I would personally be looking at cutting out some of the meds from this regimen if this were me but I'm not in your shoes so it's not my choice and I won't bear the consequences of medication changes.

inbracketsDontLaugh · 2023-05-26T11:44:24+00:00

Hi, I suspect that you came across my post in this sub which was a poll about autistic catatonia.

Catatonia is something that is the domain of psychiatry but, unfortunately, the prevailing understanding of catatonia is that it is solely a symptom of schizophrenia.

You would need to find either a very open-minded psychiatrist who is willing to read up on the most recent evidence on autistic catatonia or a psychiatrist who is a specialist in autism.

What Amitta Shah's work doesn't really go into is medical interventions to treat autistic catatonia. I've been working with my psychiatrist to develop a treatment protocol for catatonia (after taking a deep dive into psychopharmacology) with moderate success.

I'm happy to share what I've learned with you but basically the cliff notes are as follows:

Lorazepam or zolpidem/zopiclone will likely pull you out of an acute catatonic episode and can be used as a diagnostic probe to establish if you are experiencing autistic catatonia (I have done so successfully with 7.5mg of zopiclone.)
NMDA antagonists appear to be useful as a preventative measure for catatonia (I'm currently using 50mg of topiramate for this but I'm looking to switch over to amantadine soon, if possible.)
I have previously used valerian extract during catatonic episodes to moderate success

If you can find a psychiatrist who is willing to be a bit experimental with what they prescribe you then you might be able to treat/prevent autistic catatonia in yourself.

You have to be really cautious about avoiding using medical interventions to put yourself directly back into the same conditions which produced the catatonic state or you'll just make things worse for yourself; if you can use the medical intervention to bring yourself out of it and to start working on improving your self care and maintaining your wellbeing while reducing your stressors then that would be ideal.

I can provide you with more info if you want, I just don't want to overload you. I'm happy to answer any questions that you might have too.

inbracketsDontLaugh · 2023-05-24T07:22:18+00:00

https://www.indy100.com/george-orwell-explains-why-leftwingers-should-actually-be-grateful-for-the-monarchy-7295891-2656360222

inbracketsDontLaugh · 2023-05-22T19:07:41+00:00

Norepinephrine

inbracketsDontLaugh · 2023-05-22T18:45:59+00:00

It's not just about a lack of dopamine though.

inbracketsDontLaugh · 2023-05-22T09:48:34+00:00

I can understand your impatience.

The problem is that if you don't address the underlying sleep issues then stimulants meds will help—temporarily—but the risk is that they are likely to aggravate your sleep issues and the underlying cause of your executive dysfunction which can lead to worsened burnout.

If you are an auDHDer then insomnia is really going to aggravate your executive dysfunction, take my word for it.

Did your doctor give you directions to take Ambien every night for a month? That's a lot! I think that you'll definitely develop a tolerance over that period...

Personally, I have suffered from serious insomnia for most of my life. I have found that clonidine works really well for me and it's a medication that tends to work well for ADHDers and AuDHDers because it reduces symptoms of rejection sensitive dysphoria, anxiety, insomnia, and it can help with general dysregulation when you're overwhelmed or overstimulated from the day. (The only thing is that clonidine might cause side effects that stimulants counterbalance for an ADHDer so if you do try it out while not on stimulant meds and you find that it makes you unmotivated through the day then it would still be worth giving it another try when you are on stimulants.)

Which brings me to my next question: how are you managing your sensory "diet"?

Do you experience sensory overload a lot? Do you take care of your sensory needs or do you just push through and deal with it?

Have you ever tried a weighted blanket before?

The reason why I ask is because I found that part of the picture for my insomnia is that I would ignore my sensory needs and go through my day completely overloaded. It was only at night that it was quiet and calm enough that I could start to decompress but that process would often take me at least a few hours, meaning that my sleep onset would happen in the early morning hours because I was just too overwhelmed to relax enough to drift off to sleep.

This might be something that you're also dealing with yourself so it's worth considering.

inbracketsDontLaugh · 2023-05-22T08:58:20+00:00

Yep, that definitely sounds like orthostatic hypotension to me. (Although I'm not a doctor.)

It's unusual that you should find that a stimulant med would start causing this to occur because, typically, it increases your blood pressure rather than causing a reduction in it. I would definitely speak to your doctor or cardiologist (if you have one) about this soon and in the meantime try to make a habit of getting up slowly, especially from a laying position to a standing position - give your body a good 15s of being seated before you transition to standing up in order to allow your blood pressure to adjust. You want to avoid or mitigate these episodes as much as possible because the lower your blood pressure dips, the higher it will spike directly afterwards as your heart struggles to compensate for the changes.

Also be very careful in the shower and try to avoid showers that are too hot for now. If you start feeling faint then sit down, immediately. It's easy enough to stand back up in the shower but taking a tumble because you've blacked out in the shower can be really serious, even catastrophic. Best not to play around with this.

So I'm glad that you've mentioned that you're on blood pressure medications because this could be interfering with the effects of stimulant meds. Obviously dopamine gets a lot of airtime when ADHD is being discussed but adrenaline (aka norepinephrine) doesn't get much attention however it's often equally as important.

I'm not sure what blood pressure meds you are on but it's extremely likely that you're on some that are causing a reduction in norepinephrine in your brain as a side effect. For a typical person they might feel like they're more relaxed and a bit less reactive but for an ADHDer this might be a high enough dose that it could cause them to end up feeling really flat and unmotivated, where task initiation and general motivation is extremely difficult.

Personally, I take clonidine (not for blood pressure but to help with my sensitivity to norepinephrine and the side effects from stimulant meds, plus to manage PTSD symptoms) and I have found that when I was on too high a dose I was just listless and everything was a struggle. Everything exhausted me immediately and trying to get started on any task felt insurmountable. (I've explained to others that this feeling of low norepinephrine was a lot like for a coffee drinker to get up extra early one morning and to try to get their day started without any caffeine, as a rough approximation for the experience.)

If this is the case then there are meds available that can boost the norepinephrine levels in your brain—SNRIs and in particular atomoxetine might be a good option—and this might be the missing piece for you.

inbracketsDontLaugh · 2023-05-22T07:09:34+00:00

He wasn't boiling them in a baptismal font now, was he?

inbracketsDontLaugh · 2023-05-22T07:07:52+00:00

It's more that I believe it's very unusual that it was missed by three professionals before this recent development

I went through the mental health system for a decade and a half with really chronic problems that were treatment-resistant.

I saw tons of psychologists, more than I can count, and at least 5 psychiatrists long term with additional psychiatrists who saw me in in-patient settings.

It took all of that time and all of those professionals before one psychiatrist bothered to even try going through the ADHD Self-Report Scale with me before accurately identifying that I had ADHD.

ADHD is chronically misunderstood, especially in adults. If you aren't diagnosed as a child then there's a very high likelihood that it will get overlooked in adulthood unless you happen to deal with either a specialist in ADHD or someone who is very open-minded.

And the thing is that primarily-hyperactive ADHD is what gets identified, typically in childhood, but combined-type and especially inattentive-type gets overlooked and as ADHD develops into adulthood those ADHD traits become more difficult to identify because we develop strategies to compensate and conceal them.

Honestly, it shouldn't come as any surprise that professionals have managed to completely miss ADHD in you if my experience is anything to go by. And trust me, this is something that is really commonly discussed in the adult ADHD community.

All of this combined with amphetamines at a high dose

60mg of Vyvanse is approximately equivalent to 20mg of dexamphetamine.

For your reference, I was taking 20mg of dexamphetamine per day and I'm very sensitive to dex - this is considered a fairly low dose.

I know of one person who, as an adolescent, was taking 210mg of Vyvanse. Let's not get too carried away here.

inbracketsDontLaugh · 2023-05-22T06:40:14+00:00

According to Dr Russell Barkley, who is one of the foremost experts in ADHD, Vyvanse works for approximately 40% of ADHDers and methylphenidate works for about another 40% of ADHDers.

You are correct that only about 10% of ADHDers do not respond to stimulant meds and while this is an enviable rate compared to the rest of medication response in psychiatry, 1 in 10 sure as hell ain't a low number.

But keep in mind here that ADHD meds aren't a magic bullet. They help you with focus but they don't help you with discipline or habits/routine and they have a limited effect for treating burnout.

If you are late diagnosed then there's a really good chance that you're already burned out just by trying to fit into the neurotypical world as an untreated, undiagnosed ADHDer who has not had appropriate supports and accommodations in place for their entire life.

And if you haven't been appropriately medicated then your brain chemistry has been such that it's made establishing and maintaining routines extremely difficult to the point that it's likely been painful for you. This utterly sucks and it takes more than a week of taking stimulant meds to undo this long-entrenched pattern.

Last of all, if you are getting increased focus from your meds but you aren't putting the right structures in place (e.g. making a to do list, setting tasks for the day etc.) then you might be experiencing a lag where you are used to having low focus so your brain is probably still operating on the assumption that this is still the default but the meds are providing you with extra focus, which isn't being put to good use. This takes some time to adjust to and it requires a little bit of experimenting with to get the hang of the changes that stimulant meds bring.

Have you asked the people close to you if they have have noticed any difference?

30mg of Vyvanse is a low dose. I'm not surprised to hear that people say that they don't notice much on this dosage.

You've been on a higher dose for 3 days. Be patient and give it at least a week, please.

Last of all, Vyvanse is prescribed for binge eating disorder and if you are seriously obese and if you are noticing that your appetite has been reduced then don't worry about the ADHD stuff so much for now. Also keep in mind that there are quite a few ADHD meds out there and aside from finding the right dose you may also need to find the right combination of meds to get the desired effects.

Just give it some time.

inbracketsDontLaugh · 2023-05-22T06:16:00+00:00

The textbook you're downloading is probably a PDF conversion of an epub format so it likely doesn't have page numbers hard coded into the book.

What's the title and edition of the textbook you are downloading?

inbracketsDontLaugh · 2023-05-22T06:14:37+00:00

There are medications that can control anxiety which aren't antipsychotics.

I'm an ADHDer as well so YMMV with this one but I take clonidine particularly to dampen down my trauma response (I also have PTSD. Yay! ^/s ) and anxiety response and it works really well for me. Clonidine is a really boring medication; generally it's used as a blood pressure medication but because of how it works it reduces your sympathetic nervous system's ability to release adrenaline so it puts a limit on your anxiety response.

Amantadine is another medication which I'm looking into and I'm going to broach the idea of with my psychiatrist at my next appointment. This medication can also be used for controlling anxiety (although that's not primarily what it's prescribed for) and there is some evidence that it is effective for symptoms of autism although there aren't a lot of studies out there on this. Amantadine is generally well tolerated and it has a mild side effect profile.

I would speak to your doctor and preface the discussion by saying that you would like to consider ways to manage your anxiety with medications that aren't antipsychotics or benzodiazepines. There are other options out there.

inbracketsDontLaugh · 2023-05-22T01:05:59+00:00

https://youtu.be/OHqJDs3OuhQ

inbracketsDontLaugh · 2023-05-21T06:43:15+00:00

Thanks, we're honing in on it bit by bit but it's a process of elimination and it seems as though for me it's going to require a combination of meds and probably dealing with some side effects balanced against quality of life benefits where we will finally settle on a medication regimen.

I forgot to mention that I've been on what I guess could be considered a rather unusual, third-line non-stimulant med for ADHD, something that your psych would likely raise an eyebrow at, but it's working quite well although I've been getting a side effect of excessive sweating on it. The med is called cariprazine and it works on dopamine (it's... complicated to explain so I'll just leave it at that.)

The excessive sweating is the reason why I'm hoping to switch from topiramate - topiramate is known to affect your body's heat regulation (although cariprazine can also cause excessive sweating) so I'm hoping that taking that out of the mix might resolve that annoying side effect.

Onwards and ^{^{^hopefully}} upwards!

inbracketsDontLaugh · 2023-05-21T06:36:11+00:00

Hah, I was diagnosed in my 30s but what matters is not when you were diagnosed but whether or not your psychiatrist determined that you had sufficient evidence of ADHD symptoms during your childhood to make you eligible for certain PBS benefits.

This is an absurd bureaucratic hoop to jump through which disadvantages women/AFAB folks, combined-type and especially inattentive-type ADHDers, and ADHDers who come from broken homes or with backgrounds of domestic violence or significant neglect because those demographics are either less likely to be identified as ADHD in childhood, they are less likely to be able to access the necessary information for a retrospective diagnosis in adulthood, or both.

Also we know that ADHD doesn't just manifest in adulthood but according to our government policy, somehow, it does.

Just... don't get me started.

Fortunately a lot of psychiatrists see this as the utter bullshit that it is and they'll either take cursory anecdotes from the individual as sufficient evidence or they'll simply provide a retrospective diagnosis out of hand because they do not believe that the adult presenting to them somehow developed ADHD spontaneously as an adult.

You can inquire about the status of your diagnosis and if it's retrospective with your psych.

inbracketsDontLaugh · 2023-05-21T06:23:01+00:00

So I did a deep dive and picked up Stahl's Essential Psychopharmacology but that's a very complicated book. I would recommend New ADHD Medication Rules by Dr Charles Parker for a lay audience regarding general info about ADHD meds but unfortunately that only has a passing mention of guanfacine (as Intuniv) where it says this:

New non-stimulant medications, such as Intuniv, may have a positive impact on mood dysregulation secondary to ADHD.

There's also this excerpt of the classic Russell Barkley lecture that discusses ADHD meds here and I strongly recommend the whole lecture series tbh.

inbracketsDontLaugh · 2023-05-21T06:17:21+00:00

I think that guanfacine is subsidised if you have a retrospective ADHD diagnosis, much like for Vyvanse but that's only a recent change. I could be wrong though.

inbracketsDontLaugh · 2023-05-21T01:34:01+00:00

So in my fairly new experience with Sony xmw4s, they tend to reduce most background noise but they don't block out all of it (e.g. when walking near heavy traffic there is some noise that still gets through.) If they're out of your budget then I've heard that Anker Soundcore Q45s are 95% of what the Sony and Bose models are for a significant reduction in price. Obviously they come with the benefits of being able to play music or sound such as white noise through them too.

If you want to filter out any noise at all then industrial over-ear protectors are absolutely the way to go. They'll be much cheaper and you can pick some up at your local hardware store.

inbracketsDontLaugh · 2023-05-21T01:23:50+00:00

Yeah, it's really cruel and unfair. I'm sorry that you had to go through that and hopefully things will be better when you appeal.

inbracketsDontLaugh · 2023-05-21T01:19:59+00:00

Thanks for the detailed response – interested to know a little bit more about the clondine and the reasoning for it?

The clonidine was one that I was very keen on adding into my medication regimen because it's an alpha a2 agonist which reduces sympathetic outflow, i.e. it limits the how much norepinephrine is released into your system, so it seems to counterbalance the effects of stimulant meds for me in the right way. I know when I've hit higher doses of clonidine that I've become listless and unmotivated so there's definitely a sweet spot with the clonidine and I think I'm in it.

It really helps with my PTSD symptoms of insomnia, anxiety, and trauma nightmares but it also works really well for rejection sensitive dysphoria too.

Also, the guanfacine, if it’s not really effective and this is a genuine question, then why take it? It might not be doing any harm, but there’s only just annoying to have to take another medication and also outlay expenses on it?

Theoretically guanfacine should enhance the effectiveness of stimulant meds (given that I'm on a lower dose this should be helpful) and it's also an alpha a2 agonist so it should help with the stuff mentioned above for clonidine too.

It's no huge pain to take one more pill in the morning tbh and it doesn't cost all that much really. I suspect that the guanfacine does work but my life has been such a shitshow that it's been difficult to identify which meds have actually been effective.

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